|
HC Z RVRS SHOULDER 25MM
|
Facility
IP
|
$6,458.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,843.80 |
| Max. Negotiated Rate |
$6,006.31 |
| Rate for Payer: Aetna Commercial |
$5,580.06
|
| Rate for Payer: Cash Price |
$4,004.21
|
| Rate for Payer: Cigna All Commercial |
$5,573.60
|
| Rate for Payer: CORVEL All Commercial |
$6,006.31
|
| Rate for Payer: Coventry All Commercial |
$5,683.39
|
| Rate for Payer: Encore All Commercial |
$5,944.96
|
| Rate for Payer: Frontpath All Commercial |
$5,941.73
|
| Rate for Payer: Humana ChoiceCare |
$5,578.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,812.56
|
| Rate for Payer: PHCS All Commercial |
$4,843.80
|
| Rate for Payer: PHP All Commercial |
$4,898.05
|
| Rate for Payer: Sagamore Health Network All Products |
$4,985.88
|
| Rate for Payer: Signature Care EPO |
$5,360.47
|
| Rate for Payer: Signature Care PPO |
$5,683.39
|
| Rate for Payer: United Healthcare Commercial |
$5,089.22
|
|
|
HC Z RVRS SHOULDER 25MM
|
Facility
OP
|
$6,458.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,006.31 |
| Rate for Payer: Aetna Commercial |
$5,450.89
|
| Rate for Payer: Aetna Medicare |
$2,131.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,131.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,709.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,037.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,450.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,344.40
|
| Rate for Payer: Cash Price |
$4,004.21
|
| Rate for Payer: Cash Price |
$4,004.21
|
| Rate for Payer: Centivo All Commercial |
$3,293.78
|
| Rate for Payer: Cigna All Commercial |
$5,573.60
|
| Rate for Payer: CORVEL All Commercial |
$6,006.31
|
| Rate for Payer: Coventry All Commercial |
$5,683.39
|
| Rate for Payer: Encore All Commercial |
$5,944.96
|
| Rate for Payer: Frontpath All Commercial |
$5,941.73
|
| Rate for Payer: Humana ChoiceCare |
$5,578.12
|
| Rate for Payer: Humana Medicare |
$3,293.78
|
| Rate for Payer: Lucent All Commercial |
$3,293.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,812.56
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,843.80
|
| Rate for Payer: PHP All Commercial |
$4,898.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,518.78
|
| Rate for Payer: Sagamore Health Network All Products |
$4,985.88
|
| Rate for Payer: Signature Care EPO |
$5,360.47
|
| Rate for Payer: Signature Care PPO |
$5,683.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,489.64
|
| Rate for Payer: United Healthcare Commercial |
$5,089.22
|
| Rate for Payer: United Healthcare Medicare |
$2,131.27
|
|
|
HC Z RVRS SHOULDER 36MM +3
|
Facility
IP
|
$5,067.36
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,800.52 |
| Max. Negotiated Rate |
$4,712.64 |
| Rate for Payer: Aetna Commercial |
$4,378.20
|
| Rate for Payer: Cash Price |
$3,141.76
|
| Rate for Payer: Cigna All Commercial |
$4,373.13
|
| Rate for Payer: CORVEL All Commercial |
$4,712.64
|
| Rate for Payer: Coventry All Commercial |
$4,459.28
|
| Rate for Payer: Encore All Commercial |
$4,664.50
|
| Rate for Payer: Frontpath All Commercial |
$4,661.97
|
| Rate for Payer: Humana ChoiceCare |
$4,376.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,560.62
|
| Rate for Payer: PHCS All Commercial |
$3,800.52
|
| Rate for Payer: PHP All Commercial |
$3,843.09
|
| Rate for Payer: Sagamore Health Network All Products |
$3,912.00
|
| Rate for Payer: Signature Care EPO |
$4,205.91
|
| Rate for Payer: Signature Care PPO |
$4,459.28
|
| Rate for Payer: United Healthcare Commercial |
$3,993.08
|
|
|
HC Z RVRS SHOULDER 36MM +3
|
Facility
OP
|
$5,067.36
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,712.64 |
| Rate for Payer: Aetna Commercial |
$4,276.85
|
| Rate for Payer: Aetna Medicare |
$1,672.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,672.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,910.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,167.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,923.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,839.45
|
| Rate for Payer: Cash Price |
$3,141.76
|
| Rate for Payer: Cash Price |
$3,141.76
|
| Rate for Payer: Centivo All Commercial |
$2,584.35
|
| Rate for Payer: Cigna All Commercial |
$4,373.13
|
| Rate for Payer: CORVEL All Commercial |
$4,712.64
|
| Rate for Payer: Coventry All Commercial |
$4,459.28
|
| Rate for Payer: Encore All Commercial |
$4,664.50
|
| Rate for Payer: Frontpath All Commercial |
$4,661.97
|
| Rate for Payer: Humana ChoiceCare |
$4,376.68
|
| Rate for Payer: Humana Medicare |
$2,584.35
|
| Rate for Payer: Lucent All Commercial |
$2,584.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,560.62
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,800.52
|
| Rate for Payer: PHP All Commercial |
$3,843.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,976.27
|
| Rate for Payer: Sagamore Health Network All Products |
$3,912.00
|
| Rate for Payer: Signature Care EPO |
$4,205.91
|
| Rate for Payer: Signature Care PPO |
$4,459.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,307.26
|
| Rate for Payer: United Healthcare Commercial |
$3,993.08
|
| Rate for Payer: United Healthcare Medicare |
$1,672.23
|
|
|
HC Z RVRS SHOULDER 36MM +6
|
Facility
IP
|
$5,067.36
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,800.52 |
| Max. Negotiated Rate |
$4,712.64 |
| Rate for Payer: Aetna Commercial |
$4,378.20
|
| Rate for Payer: Cash Price |
$3,141.76
|
| Rate for Payer: Cigna All Commercial |
$4,373.13
|
| Rate for Payer: CORVEL All Commercial |
$4,712.64
|
| Rate for Payer: Coventry All Commercial |
$4,459.28
|
| Rate for Payer: Encore All Commercial |
$4,664.50
|
| Rate for Payer: Frontpath All Commercial |
$4,661.97
|
| Rate for Payer: Humana ChoiceCare |
$4,376.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,560.62
|
| Rate for Payer: PHCS All Commercial |
$3,800.52
|
| Rate for Payer: PHP All Commercial |
$3,843.09
|
| Rate for Payer: Sagamore Health Network All Products |
$3,912.00
|
| Rate for Payer: Signature Care EPO |
$4,205.91
|
| Rate for Payer: Signature Care PPO |
$4,459.28
|
| Rate for Payer: United Healthcare Commercial |
$3,993.08
|
|
|
HC Z RVRS SHOULDER 36MM +6
|
Facility
OP
|
$5,067.36
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,712.64 |
| Rate for Payer: Aetna Commercial |
$4,276.85
|
| Rate for Payer: Aetna Medicare |
$1,672.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,672.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,910.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,167.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,923.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,839.45
|
| Rate for Payer: Cash Price |
$3,141.76
|
| Rate for Payer: Cash Price |
$3,141.76
|
| Rate for Payer: Centivo All Commercial |
$2,584.35
|
| Rate for Payer: Cigna All Commercial |
$4,373.13
|
| Rate for Payer: CORVEL All Commercial |
$4,712.64
|
| Rate for Payer: Coventry All Commercial |
$4,459.28
|
| Rate for Payer: Encore All Commercial |
$4,664.50
|
| Rate for Payer: Frontpath All Commercial |
$4,661.97
|
| Rate for Payer: Humana ChoiceCare |
$4,376.68
|
| Rate for Payer: Humana Medicare |
$2,584.35
|
| Rate for Payer: Lucent All Commercial |
$2,584.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,560.62
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,800.52
|
| Rate for Payer: PHP All Commercial |
$3,843.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,976.27
|
| Rate for Payer: Sagamore Health Network All Products |
$3,912.00
|
| Rate for Payer: Signature Care EPO |
$4,205.91
|
| Rate for Payer: Signature Care PPO |
$4,459.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,307.26
|
| Rate for Payer: United Healthcare Commercial |
$3,993.08
|
| Rate for Payer: United Healthcare Medicare |
$1,672.23
|
|
|
HC Z RVRS SHOULDER 40 LO +3
|
Facility
OP
|
$7,020.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,528.60 |
| Rate for Payer: Aetna Commercial |
$5,924.88
|
| Rate for Payer: Aetna Medicare |
$2,316.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,316.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,031.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,388.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,664.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,548.26
|
| Rate for Payer: Cash Price |
$4,352.40
|
| Rate for Payer: Cash Price |
$4,352.40
|
| Rate for Payer: Centivo All Commercial |
$3,580.20
|
| Rate for Payer: Cigna All Commercial |
$6,058.26
|
| Rate for Payer: CORVEL All Commercial |
$6,528.60
|
| Rate for Payer: Coventry All Commercial |
$6,177.60
|
| Rate for Payer: Encore All Commercial |
$6,461.91
|
| Rate for Payer: Frontpath All Commercial |
$6,458.40
|
| Rate for Payer: Humana ChoiceCare |
$6,063.17
|
| Rate for Payer: Humana Medicare |
$3,580.20
|
| Rate for Payer: Lucent All Commercial |
$3,580.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,318.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,265.00
|
| Rate for Payer: PHP All Commercial |
$5,323.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,737.80
|
| Rate for Payer: Sagamore Health Network All Products |
$5,419.44
|
| Rate for Payer: Signature Care EPO |
$5,826.60
|
| Rate for Payer: Signature Care PPO |
$6,177.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,967.00
|
| Rate for Payer: United Healthcare Commercial |
$5,531.76
|
| Rate for Payer: United Healthcare Medicare |
$2,316.60
|
|
|
HC Z RVRS SHOULDER 40 LO +3
|
Facility
IP
|
$7,020.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,265.00 |
| Max. Negotiated Rate |
$6,528.60 |
| Rate for Payer: Aetna Commercial |
$6,065.28
|
| Rate for Payer: Cash Price |
$4,352.40
|
| Rate for Payer: Cigna All Commercial |
$6,058.26
|
| Rate for Payer: CORVEL All Commercial |
$6,528.60
|
| Rate for Payer: Coventry All Commercial |
$6,177.60
|
| Rate for Payer: Encore All Commercial |
$6,461.91
|
| Rate for Payer: Frontpath All Commercial |
$6,458.40
|
| Rate for Payer: Humana ChoiceCare |
$6,063.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,318.00
|
| Rate for Payer: PHCS All Commercial |
$5,265.00
|
| Rate for Payer: PHP All Commercial |
$5,323.97
|
| Rate for Payer: Sagamore Health Network All Products |
$5,419.44
|
| Rate for Payer: Signature Care EPO |
$5,826.60
|
| Rate for Payer: Signature Care PPO |
$6,177.60
|
| Rate for Payer: United Healthcare Commercial |
$5,531.76
|
|
|
HC Z RVRS SHOULDER 40 STD
|
Facility
IP
|
$7,020.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,265.00 |
| Max. Negotiated Rate |
$6,528.60 |
| Rate for Payer: Aetna Commercial |
$6,065.28
|
| Rate for Payer: Cash Price |
$4,352.40
|
| Rate for Payer: Cigna All Commercial |
$6,058.26
|
| Rate for Payer: CORVEL All Commercial |
$6,528.60
|
| Rate for Payer: Coventry All Commercial |
$6,177.60
|
| Rate for Payer: Encore All Commercial |
$6,461.91
|
| Rate for Payer: Frontpath All Commercial |
$6,458.40
|
| Rate for Payer: Humana ChoiceCare |
$6,063.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,318.00
|
| Rate for Payer: PHCS All Commercial |
$5,265.00
|
| Rate for Payer: PHP All Commercial |
$5,323.97
|
| Rate for Payer: Sagamore Health Network All Products |
$5,419.44
|
| Rate for Payer: Signature Care EPO |
$5,826.60
|
| Rate for Payer: Signature Care PPO |
$6,177.60
|
| Rate for Payer: United Healthcare Commercial |
$5,531.76
|
|
|
HC Z RVRS SHOULDER 40 STD
|
Facility
OP
|
$7,020.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,528.60 |
| Rate for Payer: Aetna Commercial |
$5,924.88
|
| Rate for Payer: Aetna Medicare |
$2,316.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,316.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,031.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,388.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,664.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,548.26
|
| Rate for Payer: Cash Price |
$4,352.40
|
| Rate for Payer: Cash Price |
$4,352.40
|
| Rate for Payer: Centivo All Commercial |
$3,580.20
|
| Rate for Payer: Cigna All Commercial |
$6,058.26
|
| Rate for Payer: CORVEL All Commercial |
$6,528.60
|
| Rate for Payer: Coventry All Commercial |
$6,177.60
|
| Rate for Payer: Encore All Commercial |
$6,461.91
|
| Rate for Payer: Frontpath All Commercial |
$6,458.40
|
| Rate for Payer: Humana ChoiceCare |
$6,063.17
|
| Rate for Payer: Humana Medicare |
$3,580.20
|
| Rate for Payer: Lucent All Commercial |
$3,580.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,318.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,265.00
|
| Rate for Payer: PHP All Commercial |
$5,323.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,737.80
|
| Rate for Payer: Sagamore Health Network All Products |
$5,419.44
|
| Rate for Payer: Signature Care EPO |
$5,826.60
|
| Rate for Payer: Signature Care PPO |
$6,177.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,967.00
|
| Rate for Payer: United Healthcare Commercial |
$5,531.76
|
| Rate for Payer: United Healthcare Medicare |
$2,316.60
|
|
|
HC Z RVRS SHOULDER STD 36 MM
|
Facility
OP
|
$5,067.36
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,712.64 |
| Rate for Payer: Aetna Commercial |
$4,276.85
|
| Rate for Payer: Aetna Medicare |
$1,672.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,672.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,910.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,167.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,923.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,839.45
|
| Rate for Payer: Cash Price |
$3,141.76
|
| Rate for Payer: Cash Price |
$3,141.76
|
| Rate for Payer: Centivo All Commercial |
$2,584.35
|
| Rate for Payer: Cigna All Commercial |
$4,373.13
|
| Rate for Payer: CORVEL All Commercial |
$4,712.64
|
| Rate for Payer: Coventry All Commercial |
$4,459.28
|
| Rate for Payer: Encore All Commercial |
$4,664.50
|
| Rate for Payer: Frontpath All Commercial |
$4,661.97
|
| Rate for Payer: Humana ChoiceCare |
$4,376.68
|
| Rate for Payer: Humana Medicare |
$2,584.35
|
| Rate for Payer: Lucent All Commercial |
$2,584.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,560.62
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,800.52
|
| Rate for Payer: PHP All Commercial |
$3,843.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,976.27
|
| Rate for Payer: Sagamore Health Network All Products |
$3,912.00
|
| Rate for Payer: Signature Care EPO |
$4,205.91
|
| Rate for Payer: Signature Care PPO |
$4,459.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,307.26
|
| Rate for Payer: United Healthcare Commercial |
$3,993.08
|
| Rate for Payer: United Healthcare Medicare |
$1,672.23
|
|
|
HC Z RVRS SHOULDER STD 36 MM
|
Facility
IP
|
$5,067.36
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,800.52 |
| Max. Negotiated Rate |
$4,712.64 |
| Rate for Payer: Aetna Commercial |
$4,378.20
|
| Rate for Payer: Cash Price |
$3,141.76
|
| Rate for Payer: Cigna All Commercial |
$4,373.13
|
| Rate for Payer: CORVEL All Commercial |
$4,712.64
|
| Rate for Payer: Coventry All Commercial |
$4,459.28
|
| Rate for Payer: Encore All Commercial |
$4,664.50
|
| Rate for Payer: Frontpath All Commercial |
$4,661.97
|
| Rate for Payer: Humana ChoiceCare |
$4,376.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,560.62
|
| Rate for Payer: PHCS All Commercial |
$3,800.52
|
| Rate for Payer: PHP All Commercial |
$3,843.09
|
| Rate for Payer: Sagamore Health Network All Products |
$3,912.00
|
| Rate for Payer: Signature Care EPO |
$4,205.91
|
| Rate for Payer: Signature Care PPO |
$4,459.28
|
| Rate for Payer: United Healthcare Commercial |
$3,993.08
|
|
|
HC Z RVS TRAY +10 CO 44MM
|
Facility
IP
|
$5,921.86
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,441.40 |
| Max. Negotiated Rate |
$5,507.33 |
| Rate for Payer: Aetna Commercial |
$5,116.49
|
| Rate for Payer: Cash Price |
$3,671.55
|
| Rate for Payer: Cigna All Commercial |
$5,110.57
|
| Rate for Payer: CORVEL All Commercial |
$5,507.33
|
| Rate for Payer: Coventry All Commercial |
$5,211.24
|
| Rate for Payer: Encore All Commercial |
$5,451.07
|
| Rate for Payer: Frontpath All Commercial |
$5,448.11
|
| Rate for Payer: Humana ChoiceCare |
$5,114.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,329.67
|
| Rate for Payer: PHCS All Commercial |
$4,441.40
|
| Rate for Payer: PHP All Commercial |
$4,491.14
|
| Rate for Payer: Sagamore Health Network All Products |
$4,571.68
|
| Rate for Payer: Signature Care EPO |
$4,915.14
|
| Rate for Payer: Signature Care PPO |
$5,211.24
|
| Rate for Payer: United Healthcare Commercial |
$4,666.43
|
|
|
HC Z RVS TRAY +10 CO 44MM
|
Facility
OP
|
$5,921.86
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,507.33 |
| Rate for Payer: Aetna Commercial |
$4,998.05
|
| Rate for Payer: Aetna Medicare |
$1,954.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,954.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,400.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,701.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,247.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,149.64
|
| Rate for Payer: Cash Price |
$3,671.55
|
| Rate for Payer: Cash Price |
$3,671.55
|
| Rate for Payer: Centivo All Commercial |
$3,020.15
|
| Rate for Payer: Cigna All Commercial |
$5,110.57
|
| Rate for Payer: CORVEL All Commercial |
$5,507.33
|
| Rate for Payer: Coventry All Commercial |
$5,211.24
|
| Rate for Payer: Encore All Commercial |
$5,451.07
|
| Rate for Payer: Frontpath All Commercial |
$5,448.11
|
| Rate for Payer: Humana ChoiceCare |
$5,114.71
|
| Rate for Payer: Humana Medicare |
$3,020.15
|
| Rate for Payer: Lucent All Commercial |
$3,020.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,329.67
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,441.40
|
| Rate for Payer: PHP All Commercial |
$4,491.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,309.53
|
| Rate for Payer: Sagamore Health Network All Products |
$4,571.68
|
| Rate for Payer: Signature Care EPO |
$4,915.14
|
| Rate for Payer: Signature Care PPO |
$5,211.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,033.58
|
| Rate for Payer: United Healthcare Commercial |
$4,666.43
|
| Rate for Payer: United Healthcare Medicare |
$1,954.21
|
|
|
HC Z RVS TRAY +5 CO 44MM
|
Facility
IP
|
$5,921.86
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,441.40 |
| Max. Negotiated Rate |
$5,507.33 |
| Rate for Payer: Aetna Commercial |
$5,116.49
|
| Rate for Payer: Cash Price |
$3,671.55
|
| Rate for Payer: Cigna All Commercial |
$5,110.57
|
| Rate for Payer: CORVEL All Commercial |
$5,507.33
|
| Rate for Payer: Coventry All Commercial |
$5,211.24
|
| Rate for Payer: Encore All Commercial |
$5,451.07
|
| Rate for Payer: Frontpath All Commercial |
$5,448.11
|
| Rate for Payer: Humana ChoiceCare |
$5,114.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,329.67
|
| Rate for Payer: PHCS All Commercial |
$4,441.40
|
| Rate for Payer: PHP All Commercial |
$4,491.14
|
| Rate for Payer: Sagamore Health Network All Products |
$4,571.68
|
| Rate for Payer: Signature Care EPO |
$4,915.14
|
| Rate for Payer: Signature Care PPO |
$5,211.24
|
| Rate for Payer: United Healthcare Commercial |
$4,666.43
|
|
|
HC Z RVS TRAY +5 CO 44MM
|
Facility
OP
|
$5,921.86
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,507.33 |
| Rate for Payer: Aetna Commercial |
$4,998.05
|
| Rate for Payer: Aetna Medicare |
$1,954.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,954.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,400.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,701.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,247.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,149.64
|
| Rate for Payer: Cash Price |
$3,671.55
|
| Rate for Payer: Cash Price |
$3,671.55
|
| Rate for Payer: Centivo All Commercial |
$3,020.15
|
| Rate for Payer: Cigna All Commercial |
$5,110.57
|
| Rate for Payer: CORVEL All Commercial |
$5,507.33
|
| Rate for Payer: Coventry All Commercial |
$5,211.24
|
| Rate for Payer: Encore All Commercial |
$5,451.07
|
| Rate for Payer: Frontpath All Commercial |
$5,448.11
|
| Rate for Payer: Humana ChoiceCare |
$5,114.71
|
| Rate for Payer: Humana Medicare |
$3,020.15
|
| Rate for Payer: Lucent All Commercial |
$3,020.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,329.67
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,441.40
|
| Rate for Payer: PHP All Commercial |
$4,491.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,309.53
|
| Rate for Payer: Sagamore Health Network All Products |
$4,571.68
|
| Rate for Payer: Signature Care EPO |
$4,915.14
|
| Rate for Payer: Signature Care PPO |
$5,211.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,033.58
|
| Rate for Payer: United Healthcare Commercial |
$4,666.43
|
| Rate for Payer: United Healthcare Medicare |
$1,954.21
|
|
|
HC Z RVS TRAY CO 44MM
|
Facility
OP
|
$5,921.86
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,507.33 |
| Rate for Payer: Aetna Commercial |
$4,998.05
|
| Rate for Payer: Aetna Medicare |
$1,954.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,954.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,400.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,701.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,247.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,149.64
|
| Rate for Payer: Cash Price |
$3,671.55
|
| Rate for Payer: Cash Price |
$3,671.55
|
| Rate for Payer: Centivo All Commercial |
$3,020.15
|
| Rate for Payer: Cigna All Commercial |
$5,110.57
|
| Rate for Payer: CORVEL All Commercial |
$5,507.33
|
| Rate for Payer: Coventry All Commercial |
$5,211.24
|
| Rate for Payer: Encore All Commercial |
$5,451.07
|
| Rate for Payer: Frontpath All Commercial |
$5,448.11
|
| Rate for Payer: Humana ChoiceCare |
$5,114.71
|
| Rate for Payer: Humana Medicare |
$3,020.15
|
| Rate for Payer: Lucent All Commercial |
$3,020.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,329.67
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,441.40
|
| Rate for Payer: PHP All Commercial |
$4,491.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,309.53
|
| Rate for Payer: Sagamore Health Network All Products |
$4,571.68
|
| Rate for Payer: Signature Care EPO |
$4,915.14
|
| Rate for Payer: Signature Care PPO |
$5,211.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,033.58
|
| Rate for Payer: United Healthcare Commercial |
$4,666.43
|
| Rate for Payer: United Healthcare Medicare |
$1,954.21
|
|
|
HC Z RVS TRAY CO 44MM
|
Facility
IP
|
$5,921.86
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,441.40 |
| Max. Negotiated Rate |
$5,507.33 |
| Rate for Payer: Aetna Commercial |
$5,116.49
|
| Rate for Payer: Cash Price |
$3,671.55
|
| Rate for Payer: Cigna All Commercial |
$5,110.57
|
| Rate for Payer: CORVEL All Commercial |
$5,507.33
|
| Rate for Payer: Coventry All Commercial |
$5,211.24
|
| Rate for Payer: Encore All Commercial |
$5,451.07
|
| Rate for Payer: Frontpath All Commercial |
$5,448.11
|
| Rate for Payer: Humana ChoiceCare |
$5,114.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,329.67
|
| Rate for Payer: PHCS All Commercial |
$4,441.40
|
| Rate for Payer: PHP All Commercial |
$4,491.14
|
| Rate for Payer: Sagamore Health Network All Products |
$4,571.68
|
| Rate for Payer: Signature Care EPO |
$4,915.14
|
| Rate for Payer: Signature Care PPO |
$5,211.24
|
| Rate for Payer: United Healthcare Commercial |
$4,666.43
|
|
|
HC Z SCP KNEE KIT ACCUPORT 5 ML
|
Facility
OP
|
$11,340.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,546.20 |
| Rate for Payer: Aetna Commercial |
$9,570.96
|
| Rate for Payer: Aetna Medicare |
$3,742.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,742.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,512.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,088.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,303.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,116.42
|
| Rate for Payer: Cash Price |
$7,030.80
|
| Rate for Payer: Cash Price |
$7,030.80
|
| Rate for Payer: Centivo All Commercial |
$5,783.40
|
| Rate for Payer: Cigna All Commercial |
$9,786.42
|
| Rate for Payer: CORVEL All Commercial |
$10,546.20
|
| Rate for Payer: Coventry All Commercial |
$9,979.20
|
| Rate for Payer: Encore All Commercial |
$10,438.47
|
| Rate for Payer: Frontpath All Commercial |
$10,432.80
|
| Rate for Payer: Humana ChoiceCare |
$9,794.36
|
| Rate for Payer: Humana Medicare |
$5,783.40
|
| Rate for Payer: Lucent All Commercial |
$5,783.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,206.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,505.00
|
| Rate for Payer: PHP All Commercial |
$8,600.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,422.60
|
| Rate for Payer: Sagamore Health Network All Products |
$8,754.48
|
| Rate for Payer: Signature Care EPO |
$9,412.20
|
| Rate for Payer: Signature Care PPO |
$9,979.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,639.00
|
| Rate for Payer: United Healthcare Commercial |
$8,935.92
|
| Rate for Payer: United Healthcare Medicare |
$3,742.20
|
|
|
HC Z SCP KNEE KIT ACCUPORT 5 ML
|
Facility
IP
|
$11,340.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,505.00 |
| Max. Negotiated Rate |
$10,546.20 |
| Rate for Payer: Aetna Commercial |
$9,797.76
|
| Rate for Payer: Cash Price |
$7,030.80
|
| Rate for Payer: Cigna All Commercial |
$9,786.42
|
| Rate for Payer: CORVEL All Commercial |
$10,546.20
|
| Rate for Payer: Coventry All Commercial |
$9,979.20
|
| Rate for Payer: Encore All Commercial |
$10,438.47
|
| Rate for Payer: Frontpath All Commercial |
$10,432.80
|
| Rate for Payer: Humana ChoiceCare |
$9,794.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,206.00
|
| Rate for Payer: PHCS All Commercial |
$8,505.00
|
| Rate for Payer: PHP All Commercial |
$8,600.26
|
| Rate for Payer: Sagamore Health Network All Products |
$8,754.48
|
| Rate for Payer: Signature Care EPO |
$9,412.20
|
| Rate for Payer: Signature Care PPO |
$9,979.20
|
| Rate for Payer: United Healthcare Commercial |
$8,935.92
|
|
|
HC Z SCREW 1.5X10 LOCK
|
Facility
OP
|
$579.74
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$191.31 |
| Max. Negotiated Rate |
$539.16 |
| Rate for Payer: Aetna Commercial |
$489.30
|
| Rate for Payer: Aetna Medicare |
$191.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$191.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$332.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$362.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$220.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$210.45
|
| Rate for Payer: Cash Price |
$359.44
|
| Rate for Payer: Cash Price |
$359.44
|
| Rate for Payer: Centivo All Commercial |
$295.67
|
| Rate for Payer: Cigna All Commercial |
$500.32
|
| Rate for Payer: CORVEL All Commercial |
$539.16
|
| Rate for Payer: Coventry All Commercial |
$510.17
|
| Rate for Payer: Encore All Commercial |
$533.65
|
| Rate for Payer: Frontpath All Commercial |
$533.36
|
| Rate for Payer: Humana ChoiceCare |
$500.72
|
| Rate for Payer: Humana Medicare |
$295.67
|
| Rate for Payer: Lucent All Commercial |
$295.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$521.77
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$434.80
|
| Rate for Payer: PHP All Commercial |
$439.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$226.10
|
| Rate for Payer: Sagamore Health Network All Products |
$447.56
|
| Rate for Payer: Signature Care EPO |
$481.18
|
| Rate for Payer: Signature Care PPO |
$510.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$492.78
|
| Rate for Payer: United Healthcare Commercial |
$456.84
|
| Rate for Payer: United Healthcare Medicare |
$191.31
|
|
|
HC Z SCREW 1.5X10 LOCK
|
Facility
IP
|
$579.74
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.80 |
| Max. Negotiated Rate |
$539.16 |
| Rate for Payer: Aetna Commercial |
$500.90
|
| Rate for Payer: Cash Price |
$359.44
|
| Rate for Payer: Cigna All Commercial |
$500.32
|
| Rate for Payer: CORVEL All Commercial |
$539.16
|
| Rate for Payer: Coventry All Commercial |
$510.17
|
| Rate for Payer: Encore All Commercial |
$533.65
|
| Rate for Payer: Frontpath All Commercial |
$533.36
|
| Rate for Payer: Humana ChoiceCare |
$500.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$521.77
|
| Rate for Payer: PHCS All Commercial |
$434.80
|
| Rate for Payer: PHP All Commercial |
$439.67
|
| Rate for Payer: Sagamore Health Network All Products |
$447.56
|
| Rate for Payer: Signature Care EPO |
$481.18
|
| Rate for Payer: Signature Care PPO |
$510.17
|
| Rate for Payer: United Healthcare Commercial |
$456.84
|
|
|
HC Z SCREW 1.5X10 NON LOCK
|
Facility
OP
|
$579.74
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$191.31 |
| Max. Negotiated Rate |
$539.16 |
| Rate for Payer: Aetna Commercial |
$489.30
|
| Rate for Payer: Aetna Medicare |
$191.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$191.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$332.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$362.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$220.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$210.45
|
| Rate for Payer: Cash Price |
$359.44
|
| Rate for Payer: Cash Price |
$359.44
|
| Rate for Payer: Centivo All Commercial |
$295.67
|
| Rate for Payer: Cigna All Commercial |
$500.32
|
| Rate for Payer: CORVEL All Commercial |
$539.16
|
| Rate for Payer: Coventry All Commercial |
$510.17
|
| Rate for Payer: Encore All Commercial |
$533.65
|
| Rate for Payer: Frontpath All Commercial |
$533.36
|
| Rate for Payer: Humana ChoiceCare |
$500.72
|
| Rate for Payer: Humana Medicare |
$295.67
|
| Rate for Payer: Lucent All Commercial |
$295.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$521.77
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$434.80
|
| Rate for Payer: PHP All Commercial |
$439.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$226.10
|
| Rate for Payer: Sagamore Health Network All Products |
$447.56
|
| Rate for Payer: Signature Care EPO |
$481.18
|
| Rate for Payer: Signature Care PPO |
$510.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$492.78
|
| Rate for Payer: United Healthcare Commercial |
$456.84
|
| Rate for Payer: United Healthcare Medicare |
$191.31
|
|
|
HC Z SCREW 1.5X10 NON LOCK
|
Facility
IP
|
$579.74
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.80 |
| Max. Negotiated Rate |
$539.16 |
| Rate for Payer: Aetna Commercial |
$500.90
|
| Rate for Payer: Cash Price |
$359.44
|
| Rate for Payer: Cigna All Commercial |
$500.32
|
| Rate for Payer: CORVEL All Commercial |
$539.16
|
| Rate for Payer: Coventry All Commercial |
$510.17
|
| Rate for Payer: Encore All Commercial |
$533.65
|
| Rate for Payer: Frontpath All Commercial |
$533.36
|
| Rate for Payer: Humana ChoiceCare |
$500.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$521.77
|
| Rate for Payer: PHCS All Commercial |
$434.80
|
| Rate for Payer: PHP All Commercial |
$439.67
|
| Rate for Payer: Sagamore Health Network All Products |
$447.56
|
| Rate for Payer: Signature Care EPO |
$481.18
|
| Rate for Payer: Signature Care PPO |
$510.17
|
| Rate for Payer: United Healthcare Commercial |
$456.84
|
|
|
HC Z SCREW 1.5X12 LOCK
|
Facility
IP
|
$579.74
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606583
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.80 |
| Max. Negotiated Rate |
$539.16 |
| Rate for Payer: Aetna Commercial |
$500.90
|
| Rate for Payer: Cash Price |
$359.44
|
| Rate for Payer: Cigna All Commercial |
$500.32
|
| Rate for Payer: CORVEL All Commercial |
$539.16
|
| Rate for Payer: Coventry All Commercial |
$510.17
|
| Rate for Payer: Encore All Commercial |
$533.65
|
| Rate for Payer: Frontpath All Commercial |
$533.36
|
| Rate for Payer: Humana ChoiceCare |
$500.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$521.77
|
| Rate for Payer: PHCS All Commercial |
$434.80
|
| Rate for Payer: PHP All Commercial |
$439.67
|
| Rate for Payer: Sagamore Health Network All Products |
$447.56
|
| Rate for Payer: Signature Care EPO |
$481.18
|
| Rate for Payer: Signature Care PPO |
$510.17
|
| Rate for Payer: United Healthcare Commercial |
$456.84
|
|
